Neumann Claudia, Velten Markus, Heik-Guth Cornelia, Strizek Brigitte, Wittmann Maria, Hilbert Tobias, Klaschik Sven
Department of Anesthesiology and Intensive Care Medicine.
Department of Gynecology and Obstetrics, University Hospital Bonn, Bonn, Germany.
Medicine (Baltimore). 2020 Sep 4;99(36):e21864. doi: 10.1097/MD.0000000000021864.
Spinal anesthesia (SpA) for elective caesarean section (CS) is often accompanied by clinically relevant arterial hypotension. The Bezold-Jarisch reflex, causing postspinal hypotension, has been shown to be antagonized by serotonin type 3 (5-HT3) blockade. Our aim was to assess if routine prophylactic administration of the 5-HT3 antagonist ondansetron (ODS) attenuates postspinal change in maternal blood pressure.Elective CS under SpA were retrospectively analyzed. Eighty parturients having routinely received 8 mg ODS prior to SpA were compared with 80 patients having not (control group).Mean arterial blood pressure significantly decreased from baseline to the postspinal period (P < .0001) without differences in blood pressure decreases between the 2 groups. This also applied to the heart rate. Overall use of cafedrine/theodrenaline was higher in the ODS group (0.8 (0.4-1.6) mL vs 0.8 (0-1.0) mL in the control group, P = .01). APGAR values showed a presumably clinically irrelevant decrease in control group compared with the ODS group.Our results suggest that routine administration of ODS in a dosage of 8 mg does not effectively attenuate postspinal change in maternal blood pressure during CS in our setting. Given the wide variability of anesthetic techniques, only large prospective and randomized multicenter trials will ultimately serve to elucidate this issue.
择期剖宫产（CS）的脊髓麻醉（SpA）常伴有具有临床意义的动脉低血压。已证实，导致脊髓麻醉后低血压的贝佐尔德-雅里什反射可被5-羟色胺3型（5-HT3）受体阻滞剂拮抗。我们的目的是评估5-HT3拮抗剂昂丹司琼（ODS）的常规预防性给药是否能减轻脊髓麻醉后产妇血压的变化。对脊髓麻醉下的择期剖宫产进行回顾性分析。将80例在脊髓麻醉前常规接受8mg ODS的产妇与80例未接受该药物的患者（对照组）进行比较。平均动脉血压从基线到脊髓麻醉后显著下降（P<0.0001），两组间血压下降无差异。心率情况也是如此。ODS组中去氧肾上腺素/肾上腺素的总体使用量更高（0.8（0.4-1.6）mL，而对照组为0.8（0-1.0）mL，P=0.01）。与ODS组相比，对照组的阿氏评分显示出可能无临床意义的下降。我们的结果表明，在我们的研究环境中，8mg剂量的ODS常规给药并不能有效减轻剖宫产脊髓麻醉后产妇血压的变化。鉴于麻醉技术的广泛变异性，只有大型前瞻性随机多中心试验最终才能阐明这个问题。
